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Spiegelhalter, Kate Lauren (2016)
Languages: English
Types: Doctoral thesis
Subjects: RC0537
Mindfulness-based Cognitive Therapy (MBCT) is a manualised psychosocial, group-based 8 week course specifically designed for people with a history of depression. This study responds to the huge growth in the credibility of MBCT as a therapeutic option in the NHS as well as a rise in the popularity and awareness of mindfulness-based interventions (MBIs). This study is based on semi-structured interviews (N=38) with stakeholders in the field of MBIs in Sussex, and an online survey of Sussex NHS Foundation Trust (SPFT) staff (N=203), as part of a wider collaborative ethnography embedded within the Trust. It contributes to existing literature on the efficacy of MBIs by exploring existing provision and follow-up support, reviewing the perceived benefits and costs of embedding MBCT into the health services. This study has a particular focus on participants of a recent SPFT Randomised Controlled Trial (RCT) ‘Mindfulness for Voices’ that investigated the efficacy of this therapy for people who hear distressing voices.\ud \ud This study brings together both the empirical and theoretical with its focus on mindfulness as a therapeutic technique that epitomises links between the mind, the body and society. This study draws on sociological work on embodiment and emotion in order to understand the experience of innovation as well as of MBIs – starting from the observation that many of those leading this area of research and implementation are also practising mindfulness. Furthermore, this study maps the theoretical shift from a narrow medical model of mental illness to one that characterises emotional health within a holistic and integrated paradigm, and which is influencing and shaping current practice.\ud \ud Key findings from this study are that MBIs, and MBCT in particular, can be beneficial to a diverse range of stakeholders within Sussex, including patient groups that were previously excluded from ‘talking cures’ such as those with a diagnosis of psychosis. Factors that influence the acceptability, visibility and utilisation of an innovation such as MBCT include the role of opinion leaders and champions in garnering support, as well as the degree to which expectations about the future of this intervention are managed. Drawing on sociologies of knowledge and innovation in the health services, the case is used to show the use of experiential knowledge alongside evidence in bringing about innovation. Clinicians also work to develop accounts of the ‘values’ at stake in MBIs; drawing on both evidence and experiential knowledge. The implementation of MBIs into the mainstream health service helps to illuminate some of these practices through being used to address conditions such as chronic pain and severe anxiety disorders which were hitherto seen as untreatable and characterised as ‘complex needs’, or medically unexplained symptoms (MUS) and which can be stigmatising.
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    • 2.1 Evidence-based medicine
    • 2.2 Evidence-based guidelines and cost 3. Implementation: enablers and barriers
    • 3.1 Context and clinical experience
    • 3.2 Opinion leaders
    • 3.3 Expectations and hope
    • 3.4 Implementation barriers 4. Contemporary mental health
    • 4.1 Changing service provision and focus
    • 4.2 Talking Therapies
    • 4.3 Choice and consumption 5. Challenges to dominant discourses
    • 5.1 Complementary and alternative medicine
    • 5.2 Values-based medicine
    • 5.3 Rise of recovery and user involvement 6. Mindfulness-based interventions
    • 6.1 Evidence and recent applications
    • 6.2 Meeting of epistemologies in mental health
    • 6.3 Mindfulness within complementary medicine
    • 6.3.1 Mindfulness and medicalization
    • 6.3 Latest applications and limits of Mindfulness-based
    • interventions 7. Conclusions CHAPTER 4. METHODOLOGICAL DISCUSSION 1. Introduction 2. Epistemological and ontological stance 3. Case study approach 4. Practicalities of collaboration 5. Methods
    • 5.1 Triangulation
    • 5.2 Recruitment and sampling
    • 5.3 Data collection
    • 5.4 Semi-structured interviews
    • 5.5 Online survey 6. Data analysis
    • 6.1 Qualitative analysis
    • 6.2 Quantitative analysis 43 45 47 47 48 49 51 51 51 53 54 56 56 59 60 63 63 70 72 74 76
    • 6.3 Critiques of chosen analytic methods 7. Data reporting 8. Ethical considerations
    • 8.1 Risks to participants
    • 8.2 Risks to researcher 11. Conclusions CHAPTER 5. 'LIVED EXPERIENCE'; EMOTION AND EMBODIMENT IN MINDFULNESS-BASED INTERVENTIONS 1. Emotions and embodiment 2. Mind/body interaction within mindfulness courses
    • 2.1 Meditation
    • 2.2 Mindfulness of breathing
    • 2.3 Body scan 3. Reflections on the mind/body/emotion relationship 4. Emotional labour and management
    • 4.1 Key themes
    • 4.1.1 Management of thought patterns
    • 4.1.2 Ability to deal with difficulties
    • 4.1.3 Emotional capabilities 5. The integrated self 6. Conclusions: embodied relationality CHAPTER 6. INNOVATION; EXPANDING THE REACH OF MINDFULNESS-BASED INTERVENTIONS 1. Innovation in context 2. Evidence
    • 2.1 Evidence appraisal 3. Sussex Partnership Foundation Trust (SPFT)
    • 3.1 Organisational narratives
    • 3.1.1 Supportive climate
    • 3.2 Latest application of innovation 4. Role and influence of embedded individuals
    • 4.1 Champions and opinion leaders
    • 4.1.1 Emotional climate
    • 4.2 Experiential knowledge 5. Stress and wellbeing at work 6. Clinical implementation 103 104 105 105 108 108 110 110 111 111 112 113 115 117 117 118 122 123 127 136 139
    • 6.1 Awareness
    • 6.2 Increasing Access
    • 6.3 Referral behaviour 7. Dynamics of implementation 8. Conclusions: mindfulness in Sussex, the story so far CHAPTER 7. IMAGINED FUTURE OF MINDFULNESS-BASED INTERVENTIONS 1. Introduction: key agendas 2. Value and valuation 3. Cost
    • 3.1 Dominant mechanisms
    • 3.2 Guideline development
    • 3.3 Mindfulness-based intervention costs 4. Organisational logics
    • 4.1 Regimes of truth and hope
    • 4.2 Expectations: hope against 'hype' 5. Articulation of integrated models
    • 5.1 Beyond evidence-based medicine
    • 5.2 Pluralistic values of Mindfulness-based interventions
    • 5.2.1 Cultural critique in secular context
    • 5.2.2 Value of 'Mindfulness for Voices' trial 6. Sustaining value
    • 6.1 Prevention as partial imagining
    • 6.2 Specific mechanisms
    • 6.2.1 SPFT and staff values
    • 6.2.2 'Beyond the fluffy': framing and targeting 7. Contextual constraints 8. Conclusions; a hopeful future? CHAPTER 8. FINAL REFLECTIONS 1. Introduction 2. Summary of key findings 3. Directions for future research 4. Concluding comments BIBLIOGRAPHY APPENDICES 1. Research Passport issued by SPFT (first page) 2. Research journal extracts 176 178 180 185 191 193 3. Consent form used for M4V interviews 4. Online survey for SPFT clinicians 5. NVivo coding structure report 6. Framework Analysis table example 7. Initial topic guide for interviews with mindfulness teachers 8. Table 2 showing responses in the online survey to whether
    • with difficulties in their day-to-day life 9. Details of each of the major centres of mindfulness in the UK 10. SPFT guidelines for referral criteria for MBCT courses 11. Maps 1 and 2 and table of MBI provision across Sussex 12. Table 4 MBI service provision across East and West Sussex 13. Graph 4 showing awareness of MBCT by workplace
    • within SPFT 14. ASPIRE Study Protocol 15. Table 5 showing current post-MBI support being offered
    • identified as important in the data 304 305 314 325 349 352 353 358 361 380 381 398
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